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Multicenter Study
. 2018 Feb 8;18(1):40.
doi: 10.1186/s12888-017-1581-y.

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Javier Quintero  1 , Josep A Ramos-Quiroga  2 , Javier San Sebastián  3 , Francisco Montañés  4 , Alberto Fernández-Jaén  5 , José Martínez-Raga  6 , Marta García Giral  7 , Montserrat Graell  8 , María J Mardomingo  9 , César Soutullo  10 , Jesús Eiris  11 , Montserrat Téllez  12 , Montserrat Pamias  13 , Javier Correas  14 , Juncal Sabaté  15 , Laura García-Orti  15 , José A Alda  16
Affiliations
Multicenter Study

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Javier Quintero et al. BMC Psychiatry. .

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed.

Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective.

Results: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012).

Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorder.

Keywords: ADHD; Adolescence; Economic evaluation; School children.

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Conflict of interest statement

Ethics approval and consent to participate

The central Ethics Committee that approved the study was the Niño Jesús Hospital Committee (Madrid), and all children/adolescents and their legal representatives signed a written informed consent form prior to participation in the study.

Consent for publication

Not applicable.

Competing interests

JQ: participated as speaker and/or acted as consultant for Grunenthal, Lilly, Shire, MSD, Janssen & Ferrer; received unrestricted educational and research support from Mutua Madrileña and Otsuka. JAR-Q: on the speakers bureau and/or acted as consultant for Eli Lilly, Novartis, Shire, Lundbeck, Ferrer, Medice, and Rubió; received travel awards from Rubió, Ferrer, Shire, and Eli Lilly; received unrestricted educational and research support from Eli Lilly, Shire, Rovi, Ferrer, Lundbeck, and Rubió. FM: received funding for collaborations for congress organization from Shire, Rubió, and Rovi. AF-J: received economic support to attend courses/congresses from Janssen, Eli Lilly, Rubio, Juste, Shire, and Otsuka; received fees for participation in medical congresses from Janssen, Eli Lilly, Rubio, Juste, and Shire; participated in advisory boards for Janssen, Eli Lilly, and Shire; received grants from Janssen, Eli Lilly, Rubio, and Shire. JM-R: received honoraria for being a speaker and acting on advisory boards from Shire and Janssen Pharmaceuticals. CS: received non-personal research funds for his department from Caja Navarra Foundation, Lundbeck, Shire, and Teva; served as consultant for Alicia Koplowitz Foundation, Editorial Médica Panamericana, Eli Lilly, EUNETHYDIS, Instituto de Salud Carlos III, Medice/Juste, NeuroTech Solutions Ltd., Rubió, and Shire; served on speakers bureaux on continuous medical education for Eli Lilly, Shire, Universidad Internacional Menéndez Pelayo, and Universidad Internacional de La Rioja (UNIR); received royalties from DOYMA, Editorial Médica Panamericana, and Mayo Ediciones. MT: received grant/research support from Shire Pharmaceuticals S.L., Rubio, Rovi, and Janssen. MP: participated as speaker for Lilly, Shire, and Rovi. JC: received consulting income and research support from Janssen, Shire, Ferrer, Lilly, and Lundbeck. JS and LG-O are employees of Shire. JSS, MGG, MG, MJM, and JE received support from Shire for this research. JAA: acted as consultant to or received honoraria or grants from Eli Lilly, Shire, Janssen Cilag, Rovi, Spanish Ministry of Health, Instituto de Salud Carlos III, Agència d’Informació, Avaluació i Qualitat en Salut (AIAQS), and the Alicia Koplowitz Foundation.

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Figures

Fig. 1
Fig. 1
National ADHD-related costs by cost categories
Fig. 2
Fig. 2
ADHD costs (€) in children/adolescents with adequate pharmacological treatment response versus those for whom treatment failed
See this image and copyright information in PMC

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